14852 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF tUPERTINO . 14$52
INSPECTION-DIVISION "
JOB INSPECTION RECORD
(� PERMIT'EXPI RATION
S JOB ADDRESS //4 �b UNIT# _LOT#
PERMIT EXPIRES IF WORK '
OWNER 7d Aj CONTRACTOR G-oJr./ clo"x/7' IS NOTSTARTEDWITHIN
INSPECTION[ DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 100 DAYS FROM
NOTE: - LAST CALLEDINSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED '
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PeRMIT v A L ION
CUPERTINO STANDARDS.
GARAGE SLABS y •f�
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - f-�<f /'/Poc
UNDERGROUND /SLAB
PLUMBING _
ELECTRICAL ISSUANCE DATE
MECHANICAL - BLDG ELECT - PLG. MECH,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - e BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING p If vnwnn ON
MECHANICAL
ELECTRICAL .PEHMn TO
FRAMING 71'0
INSULATION - STORIES TYPE CONSTR.
'. 00C GROUP - RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
111 11 1LLIURARFA TCTALACREAGE
ROOF ` NOTE:NO FINAL INSP.SHALL BE MADE"BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING o—Le 96 I mrl I+ES No lu Cory USE
PB U
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATEINSP. ❑ I] El 13
ASSESSORS PAHCEL NO
ROUGH SAN.# -
PLUMBING - ELECT.ENERGY .
TUBS 8 SHOWER PAN PLUMBING ENERGY iRAOT NO. PARCELNO.-
' MECHANICAL MECH.ENERGY
ELECTRICAL BUILDINGENERGY
ACC.DATE ACC FILE NO.
FRAMING - 6 - ELECT.FINAL TEST
ZONING ENG SITE NO
INSULATION PLUMBING GAS TEST - GAS
MECHANICAL FIRE SPRINK ENE ROY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ Nol v ❑ NEl
EXTERIOR SHEAR - ELECTRICAL RELEASE FLOOD ZONE A L ULC.
INTERIOR SHEARFIRE DEPT. Y❑ .N❑ v ❑ IN[]
SHEETROCK _ GRADE FEE SUMMARY
EXTERIOR LATH BUILDING "
INTERIOR LATH .� TEMPORARY APPROVALS., BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE S /
- OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC -
0� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBINGQ'
�I Z PLEASE GIVE JOB ADDRESS WHEN PHONING. ,
SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX r•
PLEASE READ REVERSE SIDE BEFORE . TOTAL
CALLING FOR FINAL INSPECTION. �r
OFFICE COPY. '
APPLICANT TO FILL IN INFORMATION WITHINIRED LINES - USE BALL POINT PENONLY
BUILDING PROJECT IDENTI FICATION - PERMIT NUMBER
ILDING - APPLICATION & PERMIT
•
ADDRESS' 14852
S�EL�t�IC UILDING-ELECTRICAL-PLUMBING-MECHANICAL
OwNER'S PLAN CHECK VALIDATION
NAME r+ Wrp�(0' OTV. ELECTRIC PERMIT FEE n
10")y PHONEm
CONTRACTOR S If /0 -
NAME b0831-�-q OUTLETS 10.00/1.00
""Lm.NO. LIGHTING FIXTURES 110.00/1.00
CONT E55 DORESS roll's `O�O �1N LC L� p�� APPLIANCES-
RESIDENTIAL 4.00
/Z
lesPHONE 3 PANELS - 10.00 DATE OF APPLICATION
ARCHrEC ^ PLAN CHECK FEE
OR PANELS (OVER 200 AMP) 20.00 P.C.NO.
ENGINEER
' LIC.NO, SIGNS TRANS. 3.00 '
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
Zm TEMP.METER OR POLE INS: 20.00 �p
APPLICANTS MOTORS
ADDRESS SEE FEE SCN.
SERVICE CHANGE 20.00
_02 LICENSED CONTRACTORS DECLARATION !►>•
r i W I hereby affirm that I am licensed under provisions of Chapter 9 B DATE
(commencing with Section 7000)of Division 3 of the Business and
H
o 4-'-.jT/ _ hod IIt 'O
01 EL CT.. PLG. MECH.
z wo m-QIsIL
License ClpLin.Number a
Date_ Contract., IDC)
-
a mw - -BUILDING PERMIT E IFa OWNER-BUILDER DECLARA'T'ION
o a w INFORMATION
w 0 I- 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
ac
04 Law far the following reason. 7031.5,Ilusimessand Professions VALUATION f/FT.
I- - g PERMIT ISSUANCE 10.00 O
Z;lit Code:Any myor county which requires aPermit loconstrucl,alter, �^ Ice
-
, Q O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIF N0. ELEC. q
wo u requites the applicant for such permit to file a signed statement that - TOTAL (x Q PERMIT TO
i he is licensed pursuant to the provisions oil the Contractor's License /T`� / I
H i Law(ChapterProcosions Coe)lh Section is 00)exempt
Dtherefoofthe _ ,�J / N
Q Business and he alleged Code)or that he is do not therefrom and DTV. PLUMBING PERMIT FEE
¢ r O the basis for the alleged exemption.An -
6 p Any of Section 703 L5 STORIES TYPE CONSTR.
o ';; $ by any applicant for h permit subjects the applicanl to a civilpenalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five hundred dollars(55001):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4,00
their sole compensation,will do the work•and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law does Rol apply to an owner of
property who builds or improves thereon•and who docs such work FIXTURES-PER TRAP 5.00 Q 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA:SYSTEM-11NC.40UTLETS 6.00
merits are not Intended or offered for sale 11,however,the building
or improvement is sold within one year al'nmrplctioo.the owner. GAS:EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or iRl- BUILDING USE
prove for purpose of sale.). RES IND CON Pa Other
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ED ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL N0.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractorts)licensed pursuant to SEWER-SANITARY-STORM V-STORM EA.200ft/10.00
Tim Contractors License Law. TRACT NO, PARCEL NO.
❑ I am exempt under Sec..,B&P,C.for this
reason WATER HEATER W/VENT 6.00
Owner - Date - WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKERS'COMPENSATION DRC.ARATION. WATER TREATING EQUIP. 5.00
I hereby affirm That I have a certificate of esmsent to self-insure,
or a certificate of Workers'Compensation Insurance,or.ecHified ZONING ENG.SITE NO.
copy thereof ISec. 0,Lab.CJ.
Polic No. ompanY y-l-r-s-t_irF(,I�
Q �Cetli ie co yis hereby furnished. FIRE SPRINK ENERGY T20
Z Z ❑ CertificI y Is Ile w' �th� city inspection division. MISC.- REFER TO ORD.
O Applicant" Y 0 N� Yo NEI
h' UI ' PERMIT ISSUANCE 10.00
• � CIiRTIIICCOM OP P�N PROM WORKERS' FLOOD ZONE A.L.U.C.
W COMPENSATION INSURANCE' PLG.CONTH., LIC.NO. PLG.
n' ❑ (This section need not be completed it the permit is for one - TOTAL Y[:] N YE] N
U O hundred dollars IS 100)or less.) -
I certify that in the performance of the work for which this per- FEE SUMMARY
- LL F mit is issued.I shall not employ any person in any mannerso as to QTY. MECHANICAL PERMIT FEE
O W become subject to the Workers'Compensation Laws of California.
M Date' Applicant' BUILDING to
} W NOTICE TO APPLICAN"f: If,after making this Certificate rf Ex- ALTER OR ADD TO MECH. 5.00
emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LCNDING AGENCY AIR HANDLING UNIT(OVER 10SMC.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Leader's Name
Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
.; ordinances and state laws refuting to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.):6.00
hereby authentioed roperty for ins inspection
this city to enter upon the BOILER_-COMP'IOvor 100,000 BTU)SEE FEE SCH., MECHANICAL
above-mentioned Property foriosp oftr i purposes,ca.
- (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
fay in l-Cwgyruv ey ip ns' said City in consequence of the
mal of[his Lima
VP\�,tlt/`r MECH.CONT. LIG NO. MECH.
L` f 0 Y TOTAL TOTAL a 6
ignatureo ,RmVwwc T
Plate
OFFICE COPY